Dementia is a public health problem of today. Dementia is characterized by a loss of or decline in memory and other cognitive abilities, and it reduces the lifespan of affected people. It is estimated that 24.3 million worldwide and 1.8 million people in India were affected with dementia. Quality of life in recent years has evolved as a very useful indicator in assessing the present overall wellbeing of an individual. Thus evaluating the quality of life in persons with dementia and finding its predictors is important. The literature review was done to form a document about the possible research scopes and policy direction in this regard. It was found that male gender, poor socioeconomic status, illiteracy, diabetes, hypertension, the presence of stigma were significant predictors of quality of life in dementia. It was also found that the presence of good caregivers and proper family support were also significant predictors for quality of life in dementia. Thus community-based studies in this regard should be conducted. Establishment of dementia-specific care centres, more awareness generation camps to reduce the stigma of dementia should be considered. Revamping the public healthcare delivery system to make it dementia friendly is an essential area for thought. Specialized health programmes on dementia are the urgent need of the country.

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Background: The importance of diagnosing delirium lies in the fact that it is potentially reversible and preventable. Delineating the clinical profile of delirium, assessing the outcome as well as observing any difference in prognosis based on age and gender could be beneficial in early intervention, thereby reducing the mortality of this clinical entity. Aims and Objectives: To study the clinical profile and outcome of elderly patients admitted with delirium and to study the relationship of age and sex with the prognosis of delirium. Results: During the study period, 65 patients were diagnosed as confirmed cases of delirium according to the Confusion Assessment Method. The majority were in the age group between 65 and 69 years. The mortality rate was 40%. There was no difference in mortality based on age. The majority was males, and the mortality also was higher for males. Patients who presented with only altered sensorium had higher mortality. 29% of people had a single cause for delirium while the remaining 71% had two or more causes. In the former group, the mortality rate was 47.4% and 37% in the latter group. Conclusions: The outcome of delirium is grave. More than one cause for delirium need not necessarily cause a worse outcome. The presence of major risk factors determines the worse outcome. Age alone is not a determining factor in the outcome of delirium. There is no statistically significant difference in the outcome of patients with delirium based on their sex. The most common in-hospital outcome of delirium is a complete recovery.

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Background: India has acquired the label of ageing nation with 9% of its population being more than 60 years old. Both perceived health and chronic illness are major elements of health status in elderly and there is growing evidence that older people are at risk for manifold co-morbidities. The health problems associated with ageing are multiple and sparse data are available on health status of elderly from hospital source. Hence, this study has made an attempt to bring out hospital-based data, highlights dimensions of the health issues which helps in better understanding of disease patterns in elderly and data for policy makers. Methods: A prospective clinical profile of one hundred elderly (>60 years) patients admitted under geriatric clinic care of BLDE (DU), Shri B M Patil Medical College Hospital and Research Centre, Vijayapura over a period of twelve months is studied. The patients admitted in emergency wards are excluded. Results: Out of one hundred patients admitted, 60% were females. Majority (65%) were in age group of 60-74 years. The common symptom of presentation was breathlessness (30%). The commonest co morbid present was hypertension (21%). The final diagnosis was acute exacerbation of Chronic Obstructive Pulmonary Disease in 16%. The overall mortality was 5%. Conclusion: Elderly people are occupying more number of beds and for prolonged duration. It makes a greater demand on health services. A multidimensional and holistic approach to multi comorbidity state in elderly can be best provided by a medical college hospital at affordable cost and adequate quality, which is need of the hour.

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A sixty-one year-old-married postmenopausal lady presented with complaints of recurrent itching and intermittent clear fluid discharge from the right nipple for last one year. The dermoscopic examination, the histopathology and the radiological findings were suggestive of Paget's disease of the breast. We report this case to reinforce the importance of suspecting malignancy in the clinical scenario of persistent unilateral breast eczema, particularly in elderly females.

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Introduction - Elderly patients have multiple comorbidities requiring treatment. Drug prescription plays an important role in the care of the elderly. Inappropriate prescribing is considered a major public health issue, given its direct association with substantial morbidity, mortality and health service costs that result from adverse drug reaction. The aim of the present study was to estimate the prevalence of inappropriate medication use in hospitalised elderly, as defined by Beers Criteria 2012. The risk factors associated with the use of potentially inappropriate medications were also evaluated. Materials and Methods - This study was done from April 2013 to August 2014 in the department of Geriatrics of a tertiary care centre in South India. Demographic parameters, comorbidities, pharmacokinetic parameters, cognitive and functional status and details of drugs (over 2 weeks) were collated. Results - Total of 280 hospitalised patients were included. The prevalence of potentially inappropriate medication use in our study was 33.2% as per Beers criteria version 2012. Use of drug with anticholinergic activity was found in 13.4% and among sedatives major contributior were benzodiazepines in 6.5% subjects. Age, depression and polypharmacy were found to be independent risk factors for potentially inappropriate medication use. Conclusion - Present study showed high prevalence of inappropriate drug use in the elderly. Effective intervention to optimise drug prescribing in elderly is therefore needed to prevent adverse drug reactions, drug interactions, cognitive impairment, falls and mortality.

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Introduction: Hyponatremia is the most frequent electrolyte abnormality encountered in clinical practice. The prospective studies on the causes and outcomes of severe hyponatremia are very few, and hence this study was undertaken. Objectives: To describe the clinical profile, aetiology and clinical outcomes of medical in-patients more than 60 years of age with severe hyponatremia (Serum Sodium ≤ 125 mEq/L) Methods: All the in-patients (≥ 60 years of age) admitted in medical units of a tertiary care hospital with severe hyponatremia (Sodium ≤125 mEq/L) at admission were recruited. Demographic profile, history, medication history, co-morbidities, clinical findings, Confusion Assessment Method score (CAM), Charlson comorbidity index and primary diagnosis for each patient was assessed. All relevant laboratory investigations were done. The patients were followed up till discharge for outcomes. The data were analyzed using SPSS 16.0 using appropriate statistical tests. Results: 109 patients were included in the study. 66% of them were males. The mean age was 69.9 years (SD 6.8). The mean sodium level was 117.6 (SD 6.2) mEq/L. 51.3% of the patients had delirium at admission. Hyponatremia was the sole cause for delirium in 31.5% of these patients. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) was the most frequent cause for hyponatremia (34.8%). The median length of hospital stay was two weeks. At discharge, 11% of the patients were still in delirium. Drugs (especially thiazide diuretics) were found to be important contributory factors for hyponatremia. 2.8% of the patients died and 16.5% left against medical advice, due to deteriorating clinical status. Conclusion: Elderly patients with severe hyponatremia may not present with typical symptoms attributable to the metabolic abnormality. Nearly a third of the delirious patients were encephalopathic because of hyponatremia. The commonest cause for severe hyponatremia was SIADH (34.8%). Drugs (especially thiazide diuretics) were implicated as an important etiological factor for hyponatremia in about one-fifth of the patients. Cognitive status improved to near normal state in a majority of patients at discharge. Severe hyponatremia was not found to be a predictor of mortality.

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Objective: To determine the association between dehydroepiandrosterone and frailty in the elderly. Methods: In this cross-sectional analytical study, older people aged 65 and above attending the geriatric outpatient and inpatient services were screened for frailty using Fried's criteria. The frailty phenotype criteria include unintentional weight loss, slow walking speed, self-reported exhaustion, reduced grip strength and reduced physical activity. Subjects having 3 of the 5 criteria are termed as frail and having 1 or 2 criteria are termed as intermediate-frail and having none of the criteria is termed as non-frail, 33 frail, 34 intermediate-frail and 33 non-frail subjects were randomly selected from the screened subjects to participate in the study. Dehydroepiandrosterone sulphate ester (DHEAS) level in all the study subjects was measured. Results: Of the 100 study subjects, 53 were males, and 47 were females. The mean age of the study participants was 77.12 years. The frailty phenotype increased with advancing age. The mean DHEAS level was 49.55μg/dL We found an inverse relationship between the frailty categories and the DHEAS level. No gender interaction was observed in the association between frailty and DHEAS level. BMI ≥ 29 kg/m² attenuated the association found between frailty and DHEAS level. Conclusion: In this study, we found an association between frailty and DHEAS level. The DHEAS level in the frail group was lower when compared with those of the non-frail group.

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Background: Globally, non-communicable diseases (NCD) are the major cause of morbidity and mortality. A progressive rise in the disease pattern of NCD foretells a serious public health issue. Objective: To estimate risk factors in non-communicable diseases and to identify the various morbidities in the geriatric population in males and females. Methodology: This was a cross-sectional study performed in 540 geriatric patients of 60 years and above in a tertiary care hospital. A structured questionnaire was conducted to collect socio demographic information. Functional status was assessed by the basic activities of daily living. BMI and blood pressure was recorded in all subjects. Mini-mental scale, musculoskeletal history and examination, hearing test by bedside and ophthalmology examination for cataract was performed in all patients. HMG, LFT RFT, blood glucose, lipids, ECG, 2D echocardiography, ultrasound abdomen, mammography and bone densitometry (BMD) by quantitative ultra sonography was done in all patients. CXR, PFT, CT/MRI brain was performed in selected patients Results: Out of 540 geriatric patients, 310 patients were males, and 230 were females. Osteopenia (40%) and Osteoporosis (24%) was seen in females. Among the morbidities, Hypertension and Ischaemic heart disease were more in males. Arthritis and Anaemia were more in females which was statistically significant (p=0.001) Conclusion: There is an urgent need to develop geriatric health care services by providing training to health care providers to manage the commonly existing health problems among the elderly.

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